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SAN JOAQUIN Environmental Health DeparHner ' <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />fy y' y/>i. <br />2 <br />Address: <br />3 <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the fo ’o// '■g "e-'oee6. <br /> Approved bottled water. <br />0 On-site hose bib that is connected to a potable v/ater source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Note: The only operations not required to provide enclosed booths are those v/r or so oe/e'eges <br />approved dispensers, or prepackaged foods from approved sources. <br />0 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar male' a a-d f 'e "ec' '} <br />screening, completely enclosing open food areas. It will also have a smooth and clcarab'e *ioor f'zzo'e'.e <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and ‘ooc p'esa'a’.'z <br />areas from the public. <br />0 Sterno & hotel trays <br /> Steam table & lids <br />r/j Other (specify) c< <br />Hazelton Avenue I Stockton, California 95205 j T 209 468-3420 1 F 209 464-0138 //// 'zz' <br />Pflgo7crf11 TEMPEVEJfT <br /> Other (specify):__________ <br />Electricity Is provided for my booth's use: 0 Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of pofentia / raza'coz- <br />foods during all times of booth operation: H Yes No <br />I am providing the following hot temperature control for the hot holding of all polenta .y haza'coz ‘occs aoo ,e <br />135T.' <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />Name of organization/business.w_ C.' (IJk I (Sd'C. z <br />Phone: ( H-l b~ AIMnalo ( <br />List food to be sold or given to the public: <br />All food vendors (both for profit and non-profit) am mqulmd to mlum a • I'p'/ 'l imd f.-' '•“ ■ • • • <br />the festival coordinator three (3) weeks prior lo this event <br />i .Name of Event: _Lodi DGGr fGS! & BRO Ch''i,npionnl)ip <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information .about my organizallonAJU'iiro'.fi <br />I am providing food that is NOT prepared at home: 0 Yes H No <br />All food is prepared on-site or is from approved commercial facilities: 0 Ye<> No <br />Name of facility: N/A Phone: (. ) <br />Address of facility:__________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-prepara’ or area£ '■ <br />dust and the public) <br />■